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Prostate Cancer
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Posted 7/6/2018 12:10 PM (GMT 0)
Hello,
I'm 59 years old and was diagnosed in November 2017 with prostate cancer. I have read TOO much and am overwhelmed. I live in Canada and the "number" information everyone posts confuses me as we do not get all of this from our medical practitioners here. My psa was 8.6 and my gleason score 3+4=7....I was told it is T1 and the biopsy of 12 core samples showed irregularities in only 25% of ONE core. I have had a complete bone scan and they feel it is contained in one lobe of the prostate gland. The urologist advises it is most likely slow growing and I realize that with everything in life no one knows anything for sure. I have been on active surveillance since then and am scheduled for another blood test now. The urologist also wants to do another biopsy in 6 months and I am looking for informed opinions from others.
Posted 7/6/2018 1:04 PM (GMT 0)
Hi, I-T-G! Let me be the first to welcome you to our little bit of mayhem on the internet. None of us asked to be here, but let me assure you, all of us are grateful for the others who inhabit this site and help us through the many rough spots of this journey.

I am not familiar with the diagnostic and treatment protocols in Canada and how they may differ from those in place here in The States, so I won't be able to comment in too much detail. Your biopsy results aren't that different than mine. I had 3 samples of G3+3, one of G3+4. With just a small amount of the G3+4, some of the formal Active Surveillance programs do accept patients. You haven't told us enough to know if your uro has you in a formally-managed AS program or if he is just "watching and waiting." There is a big difference.

The formal AS programs (at least here in The States) all have very strict follow-up plans that participants must follow. These include additional confirmation testing (e.g. MRI, scheduled follow-up biopsies, etc.). If you're going to pursue Active Surveillance, I'd recommend that you enroll in a program managed by one of the cancer care centers or hospitals, not just what your uro wants to follow.

In my case, I didn't want to hang around and see if my G3+4 would become larger or aggressive, so I opted for treatment. As a G3+4, you are considered to be a favorable intermediate risk patient. That means that if you do opt for treatment, you have many options - including surgery, many varieties of radiation and some other targeted treatments (high-intensity ultrasound or cryo-ablation may come up). IF you opt for treatment, you owe it to yourself to investigate any treatments that may be available to you, rather than just going with whatever the doc says. Most of the primary monotherapies (single forms of treatment, used alone) have about the same cure rate, but they have different side effects. At your age, you would expect to live for many years with the side effects of whatever treatment you choose, so go into this with your eyes wide open.

I hope you do get the chance to spend many years on Active Surveillance. If you do choose to move on to treatment, do come around and let us help you learn about your options.
Posted 7/6/2018 1:14 PM (GMT 0)
Welcome.

In my view you're on a good path now, active surveillance with periodic PSA tests and a follow-up biopsy scheduled in a few months. With your numbers you're in the favorable intermediate risk group, with the 3+4 being what puts you in the intermediate risk category. As long as you can deal with the uncertainty involved in active surveillance I'd wait to see what the next biopsy shows. (There's no reason that you can't have that biopsy now as opposed to waiting a few months.)

Have you obtained a second opinion on the biopsy results? If your single core of 3+4 was actually 3+3 you would be in the very low risk category, which would be a very strong indication that active surveillance was the preferred approach.
Posted 7/6/2018 1:37 PM (GMT 0)
Welcome to HW, sorry you need to be here.

AS is a good option and it sounds like your URO has you on the normal protocol. Stick with it, you want to avoid treatment as long as possible.

Andrew
Posted 7/6/2018 1:40 PM (GMT 0)
Inthegroup, just want to add my welcome. I think in the states , G7(3+4) is still ok for AS. Seems like the same for Canada.
I’m not one of the more knowledgeable guys technically so I’ll leave it at that. But do keep a close eye on things with that PSA of 8.6.
As you know this is a pretty slow growing disease, so no need to rush into anything other than what you are doing, the confirmatory biopsy may give you some more guidance.
Good luck and keep us posted.
Posted 7/6/2018 1:41 PM (GMT 0)
We know how overwhelming this is at the beginning, but take a breath and slow down. Good advice from the guys, nothing else to add.
Posted 7/6/2018 4:41 PM (GMT 0)
I think there is a small amount of risk to go on AS as a G7, but it's not an unreasonable choice. Here is a discussion on it that might be useful to you

/prostatecancerinfolink.net/2017/07/22/low-volume-gleason-3-4-7-disease-is-active-surveillance-a-realistic-option/

I think the main takeaway is that if your first biopsy wasn't MRI targeted (or MRI showed nothing), you should get a multiparametric MRI before your next biopsy and if positive, get a MRI targeted fusion biopsy. Your ability to stay on AS is, to some extent, due to the your low cancer volume i.e., only one core sample was positive. However, as you might know, biopsies are not very precise as they spread out the 12 needles. It's quite possible that some cancer was missed. If something shows up on the MRI, they will target that area more intensively on the biopsy, which may help you decide to stay on AS or not.

Bone scans at this stage are not very useful
Posted 7/6/2018 9:08 PM (GMT 0)
Hi guys,..thanks for the quick responses I appreciate the input and guidance going forward. Sorry I did omit the fact that I did have an MRI and full bone scan, after the initial findings from the biopsy, so good for me I guess. I will continue on this path with regular psa screening and biopsies as needed. Should I see a decline I will decide then on an alternate course of treatment. Thanks again for sharing it helps tremendously.
Posted 7/6/2018 9:56 PM (GMT 0)
What did the post biopsy MRI say? Was it a multi parametric MRI?
Posted 7/7/2018 12:03 AM (GMT 0)
You could ask your URO to send your biopsy slides out to Dr. Epstein at Johns-Hopkins for a second opinion..Your future treatment and perhaps your life depends on the analysis of the local pathologist. It's important that analysis is correct..You may have to pay for this but it's worth it...
Posted 7/7/2018 9:44 AM (GMT 0)
Welcome what I gather, and we have similar levels of disease, and G7 is favorable intermediate and in the states, we can be offered AS with caution. I choose to have a decipher genomic test to get me a probability of metastasis and in my case, it came back too risky for me so I choose treatment.

As to being overwhelmed, I think that is part of the journey. Keep asking questions here and of your docs. Denis
Posted 7/7/2018 8:45 PM (GMT 0)
I would say that you're not really on AS until after you've had your confirmation biopsy. if there are any areas that are PIRADS 3-5 on your mpMRI, be sure they take 5 cores from there.
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